Provider Demographics
NPI:1427274273
Name:MARTIN, WILIAM FRASER (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILIAM
Middle Name:FRASER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 HAMMAN WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4480
Mailing Address - Country:US
Mailing Address - Phone:630-692-1922
Mailing Address - Fax:
Practice Address - Street 1:4300 COMMERCE CT
Practice Address - Street 2:300-3
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3698
Practice Address - Country:US
Practice Address - Phone:630-393-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA614103TB0200X
IL071006511103TH0004X
VA0810007396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209368Medicare PIN